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2032: A brave new medical world, predictions of the future

Virginia Thornley, M.D., Neurologist, Epileptologist

@VThornleyMD

https://neurologybuzz.com/
June 23, 2018

 

Sometime in the not too distant future, I come up to the front desk otherwise known as the receiving hub. I place my face on the pad where a laser scans the back of my retinas to pull up my information. As my information data is retrieved from the master chip after a few seconds.

As my records are processed through the data processing machine I sit in the laboratory seat where Robot series 2000 comes out. A new model replaces it in a week. It places sensors on my arm where I am punctured with 100% accuracy and automatically the results are processed in a series of pings. Series 2000 informs me in a prerecorded voice “your health care coordinator will be with you in a second.” It beeps while it takes my data from my wearable technology recording my heart rate, rhythm, respiratory rates and blood pressure.

I wait 5 seconds, irritated. This service is unacceptable I will be automating my complaint to the information receiving center. The health care coordinator comes, a new artificial intelligence device telling me everything is good projecting my data in the air with green lighting so I can see. “There are no neoplastic processes. You may continue your genetic treatments,” it says.

Medical cannabis farms quickly skyrocket in value once it is legalized. The people of the land quickly find its amazing ability to cure everything. This is truly a miracle drug everybody has not anticipated, hidden for so many years under stigma and downplay. It quickly develops its potential eradicating seizures, headaches, chronic pain, ADHD, autism, psychosis, inflammation, spasms and at high doses even cures cancer. Those who were able to get a license before the usual regulatory parties come in quickly become billionaires. Farm owners have an increasingly difficult time obtaining licenses to open a nursery as bureaucracy and the exorbitant fees weigh down the application process.

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However, chagrined and panicked, business ranks cannot deal with this. Genetic treatments are quickly advertised as the foremost treatment which nobody can afford. Premiums are now $5500 per person before insurance kicks in. Medical marijuana is once again run out of business and once again placed under prohibition for the next 100 years until the next wave of revolutionists rescue it from its slumber.

Disenchanted by the changes in medicine, some doctors start to retire by age 35. The smart ones strike gold when bitcoin and ethereum blow up, as investors cash in. Inital coin offerings have exploded into a huge business. Disenfranchised doctors sick of the way healthcare has turned for the worse open real estate empires or wellness businesses. Physicians are being stealthily accused of having slips in care in order to be placed on the chopping block.

By 2022,  extenders assume 75% of healthcare authority and no longer require supervision by law. They take care of patients and are therefore, called doctors but because they are not medical doctors they are immune from liability.  Back in 2018, they had comprised 25% of healthcare workers in rural counties. They are a huge boon to the corporates because they are paid half the wages of doctors but do essentially the same thing with less training. It’s a win-win situation for corporate greed and extenders who want autonomy without having to pay the price.

These are the new doctor practitioners. The terminology is a bit confusing to patients but it is of no matter because everybody gets to be called doctor now. With this newfound freedom, these new breeds join together and unionize, setting up shop accepting subsidies from insurance companies. The complex cases are left for the brave remaining doctors of traditional medicine. “You are all on the same team you are all managing patients, therefore, all physician doctors,” corporate management says.

Overburdened with 65 complicated cases a day, malpractice cases easily abound fleecing the remaining steadfast medical physicians.

Medical physicians are slowly and quietly replaced by trainees with now only a 6 hour certification requirement under their belt while they shadow medical physicians for a week and released to the unsuspecting patients. Unbeknownst to the medical doctors they have been training their replacements. Medical doctors slowly release all their power, as it has been quietly and slowly stripped during the past few decades. Burdened by burgeoning work requirements, they have no idea what strikes.

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Then, the corporate heads stop even with the pretense. On National Health Transformation Day, those medical physicians remaining receive pink slips from those that they trained and supervised. How could this be?

By 2028, it is a complete takeover with a few MD’s remaining in genetic research which becomes a trillion dollar industry replacing expensive medications with even more expensive genetic treatments. They are now called genomic project leaders, not even in capitalized letters, to avoid any confusion with the practicing doctors who used to be known as extenders. Basically anybody in contact with a patient is now called doctor just as teams all get trophies there are no losers, no hierarchy and feelings are not hurt.

By 2030, even these doctor practioners or whatever the politically correct term is for extenders become too expensive. In the end, there is a monopoly of healthcare controlled by a single entity. Artificial intelligence overtakes all surgeries and including entering information, gathering blood supplies, obtaining samples, biopsies, everything. Healthcare is more efficient and costlier than ever. Surgery is usurped  by employment of stem cell therapies. Data is entered in a master computer data program and diagnoses are never inaccurate. Medical treatment is now either replacement of genes or stem cell treatment. Pills are unheard of. By now, all of the workers’ wages are devoted entirely to a single care entity. Housing and food is universal, sterile and factory-like in order to contain cost.

Even the doctor replacers are replaced. AI is developed at rapid speeds. The replacements become obsolete. Even the powerful NP and PA unions could not protect them.

There are now 2 classes of people, the masses who can no longer afford healthcare and are now dependent on another system to sustain them and the elitist business class who now controls health, business and the laws of the land.

This is 2032.

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Medical Practice

Returning to the sacred patient-physician relationship

Virginia Thornley, M.D., Neurologist, Epileptologist

@VThornleyMD
https://neurologybuzz.com/

June 6, 2018

Introduction

Seeing physician burnout articles every page you swipe on social media, on physician online media groups, and in editorials of national syndicates are becoming the norm. Not to minimize it, it can become fairly discouraging reading about the fate of well-educated healers with only the noblest intentions becoming victims of the healthcare climate that is medicine today. Reading about these issues, one can become disengaged when you are in the throes of working.  It is when one becomes completely removed from the situation when you realize the extent of the dysfunctional system. Yes, the system is terrible, yes, there are too many regulations, too many middlemen, too many people getting in the way of the genuine whole-hearted connection between patient and physician. Where does that leave us and how can we rectify the situation?

Patient-physician relationship: the sacred relationship

It used to be that the relationship was between patient and physician. Patient and physician. There was no such thing as health insurances, no such thing as MOC, no such thing as EMR, no such thing as healthcare professionals. It was patient and physician. Physician and patient. Doctor and patient. Patient and doctor.

There was nothing to separate the physician from caring for his patients. Doctors used to travel with their doctor’s bags to their patient’s home, making house calls, being paid with services or what little the family had on their farms. Doctors took out their trusty stethoscopes and gave a healing balm, sometimes they helped their patients sometimes not, since the remedy was beyond the technology at the time. There was no such thing as malpractice insurance. No such thing as deductibles, no such thing as premiums, no such thing as clicking little boxes that sums up a human’s suffering. The relationship between a doctor and his patient was at its best and humblest-to care for the sick. Not to cure, not to treat but to comfort always. Absolutely nothing stood in the way between doctor and patient. That relationship was pure and untouched.

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Going back to your roots, back to the patient-physician relationship

How does one go back to this very sacred traditional relationship? If doctors do not realize this is a crisis situation where this very symbolic connection is being threatened by a huge number of many outside forces, they must be hiding under a rock. When one sees hundreds of articles on physician burnout, how to end the patient interview, courses on coding to get the most out of a visit, you know there is something utterly amiss with the system.  There will be the business end of the situation, you do have to pay for staff salaries, paper supplies etc, after all. But the physician-patient relationship is one of the most paramount human connections that cannot and should not be replaced. To heal and to comfort someone during their last few days, to determine if someone no longer has meaningful recovery after suffering from a massive myocardial infarct, to tell a patient they have a glioblastoma multiforme and there is very little chance of recovery, these are sensitive dealings that should not lay on an artificial robot, a medical substitute or a paramedical person. Important discussions like these should be with the physician. In order to have these important discussions, one must first have a relationship. One must never forget why we have entered medicine, to serve our patients. The human connection between a patient and physician is one of trust and hope. But how do we get back there when there are so many compelling factors threatening its very existence?

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Acknowledge there is a problem

A basic tenet of remedying a situation is to acknowledge that there is a problem. When one realizes the way one operates is not sustainable, your psyche will address the situation and make changes. If one stays in the limbo, the system can consume you and spit you out. Such are the sad cases of colleagues ruthlessly cut to be replaced with cheap labor by the upper business echelons.  Difficulties coping with this new unsatisfying overburdensome system leads to disillusioned physicians, who previously took pride in their work now reduced to electric circuits, cogs in a machine. And because physicians are perfectionists we feel like failures if we cannot cope. This leads to the worst case scenario which is to take your own life.

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We should find pride and satisfaction in what we do. Instead, there are now wellness programs which are a slap in the face placing the blame entirely on the physicians’ shoulders because we are unable to cope. Patients cannot fathom the extent of this medical crisis. All they know is that their physicians keep getting changed because of rapid turnover or a whole encounter is all of 10 minutes to summarize 10 complex problems. The answer lies within ourselves. Nobody can turnaround the situation except ourselves. If we want change we change our whole outlook, whole way of thinking and whole way of practice, it begins within ourselves.

Get rid of the middleman

I used to have a wonderful medical assistant, she did all the pre-questionnaires for me and dutifully entered it into the computer database. As the patient entered my office, I am guilty of saying,”hold on, let me read what my assistant typed” while the patient is seated, gob-smacked, looking at me silently. Looking back I can only shake my head and wonder,”wow, what was I thinking I sound like a cold robot,” which I was. All the boxes were checked perfectly, I did my neurological exam, whipped out my pad, scribbling 5 medications for 5 different symptoms, filled out MRI forms, went over the plan speaking as quickly as possible. Off my patient went on his merry old way, disillusioned and somehow left unfulfilled. Imagine this occurring 20 times a day. I was fried by the end of the day, my patients left dissatisfied and staff went through the office like hotel guests through revolving doors because of the tediousness that is medicine today. When I used to work in hospitals, residents did the pre-work-up as was part of their training, relationships were fleeting, care was in teams and rotations.

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Now, I see new patients for 1 hour, they are now eloquent, unique stories again, not templates that you copy and paste and change with a few details according to the patient. I let them expound until they have nothing left to say. I ask my part, perform my examination which is where the healing touch occurs that every patient subconsciously craves and we go over the plan. I answer all questions until there are no more. It is not uncommon for a patient to shake my hand heartfelt looking me in the eye thanking me. Other times, I receive a warm hug. It is not just as a courtesy gesture but a real expression of appreciation. While I did not cure them I provided so much more, the therapeutic healing relationship that exists between a patient and a doctor that no matter what happens I am now there for them. My heart warms and I modestly reply I didn’t do anything. But deep down I can feel the palpable difference. I have returned to the roots of medicine. I finally understand that this is what it is all about. I now listen to them. I listen to their own unique stories. I make eye contact and take in everything they have to say, the furrowing of their brows, the tone of their voices and I hear what they are saying. I now get comments how they are happy they found me their last doctor only took 5 minutes, while I muse to myself, I used to be that doctor. I remain neutral and non-judgmental, but I am now aware there is a simply better way of practicing now.

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How does one return to your roots

Going back to the basics of communication, human connection, one remembers the reason why you entered medicine. We are slowly replaced by parallel industries where practitioners of dubious training are hailed new miracle healers. Everybody is calling themselves doctors. They spend more time listening and are less regulated. We have lost the art of listening. It has gotten lost in the world of electronic recording, the need to generate copious amounts of data on one patient encounter, in the new team service approach. The unique relationship between doctor and patient is subsequently insidiously altered-soon to be extinct as doctors are slowly being replaced and encroached by other forces. But the solution is very simple, we must return to the country doctor model. Within the very listening provides great comfort. When comfort is achieved we have done our job. We may not cure or treat, but we always comfort. The paradigm shifts back to doctor and patient.

One more time cut out the middleman

I cannot emphasize it enough, cut out the middleman. Anything that keeps you apart from your patient widens the chasm and becomes a barrier, an impediment. Assistants, insurances, computers, physician extenders, these were never around before. When you strip it back down to the bare bones, you return to the rawest, purest form of medicine-the relationship between doctor and patient. Patient and doctor. We should go back to the country doctor model.

It is only then you will realize the depth that is medicine. Only then can we practice medicine the way it is supposed to be…between physician and patient. Patient and physician.

About

https://neurologybuzz.com/

Dr. Virginia Thornley is a Board-Certified Neurologist subspecializing in Epilepsy and Clinical Neurophysiology in private practice. You can follow her on @VThornleyMD. To read more of her writings, visit https://neurologybuzz.com/

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